Saturday, March 11, 2006

The White House vs. the Laboratory is Michael Specter's piece in this week's The New Yorker[Note: all quotes in this blog are taken from Specter's article ]. Anyone who has visited this blog with any degree of regularity knows I have no love for this Administration and so much of what it is responsible for, but Specter's article highlights another flavor of Administration Christian fundamentalist horse manure that constitutes a threat to public health and safety.

Human papillomavirus (HPV) comes in about 100 different strains, two of which are responsible for genital warts, and another two that have been tied to cancer. As one would rightly suspect, the two tied to cancer are of particular concern in the medical community. The carcinogenic versions are STDs, and while they may affect either sex they predominately are responsible for cervical cancer. The problem with HPV is that there are no tell-tale indicators that you've been infected with the cancerous version until the damage is done, and there's little to protect oneself from the virus with, though condoms are better than nothing - well, of course there's abstinence and that's pretty much 100% effective against all STDs . About 5,000 women die from cervical cancer every year in the U.S., and it's believed that a large majority of those cancers are attributable to the virus.

But there's good news, GlaxoSmithKline has come up with a vaccine for HPV and it appears that when given early enough, in childhood before sexual activity has begun, it effectively protects women from HPV infection. So what we have here is a bonafide cancer vaccine and we should all be very happy. Of course that's a bit too simplistic, i.e. we have a vaccine against a deadly disease and therefore should rejoice. No the Christian Right, with its odd logic and perspective, weighs in with Leslee J. Unruh, the founder and president of the Abstinence Clearinghouse, telling us:

"I personally object to vaccinating children when they don't need vaccinations, particularly against a disease that is one hundred percent preventable with proper sexual behavior. Premarital sex is dangerous, even deadly. Let's not encourage it by vaccinating ten-year-olds so they think they're safe."

Wow ... don't need vaccinations ... what calculus of life does anyone use to determine if one needs a vaccination or not? Ok, I can appreciate not being vaccinated for smallpox, a disease which has effectively been eradicated from the planet (barring that stored in U.S. and Russian government freezers), but HPV is everywhere so how do you rationalize not vaccinating against a reasonable possibility of infection, which may result in a deadly medical condition? Should we also not provide liver transplants to alcoholics? I mean why should we give an alcoholic the hope that they may be able to live a normal life after they destroyed their liver, doesn't that just encourage their addictive behavior? Should we withhold insulin from type II diabetics who managed to incur their disease due to bad life habits - let them know that a miserable death is the penalty for eating too many Krispy Cremes? Or more directly in keeping with Ms. Unruh's philosophy, let's withhold antibiotics from anyone who gets a bacterial STD, surely anyone who indulged the folly of premarital sex deserves the dementia that comes with late stage syphilis.

And this isn't just about HPV, no indeed, as Reginald Finger, who sits on the Center for Disease Control's Immunization Committee, which is responsible at the national level for recommending vaccinations and when they're provided, in discussing the possibility of an HIV vaccine, stated:

"We would have to look at that closely. With any vaccine for HIV, disinhibition [a medical term for the absence of fear] would certainly be a factor, and it is something we will have to pay attention to with a great deal of care."

Finger's point is that the "fear" aspect of HIV is a good thing, it supports a rationale for abstinence. So if an HIV vaccine is a dis-inhibitor then the disease itself must be considered to be an inhibitor; only some religious loop job would come through with a logic that involves a virus in some grand moral design in support of abstinence, and this particular loop job is part of the process that determines if, when, and to whom vaccinations are given.

The problem is that this application of morality to disease is rampant in government these days. Specter's article brings us Senator Tom Coburn (R-Ok), a family physician no less, who argues that since condoms can fail, the nation should stop relying on them, and who from personal experience with treating HPV infected patients states that "Studies have indicated for years that promiscuity was associated with cervical cancer." Well, yes, fine, and what does that have to do with trying to prevent or cure the disease? What logic causes one to think that they're going to cause an entire nation, or world for that matter, to suddenly come on board to abstinence? And do these people have evidence to support that strictly abstinence-based programs are the cure-all to diseases like HPV? No, they don't, in fact what's out there supports quite the contrary. So fundamentally they must expect that at least good Christians will be abstinence adherents and the rest of the world can go waste away and die - a sort of indirect religious-based genocide.

Non-abstinence is not illegal in this country, or for that matter in most countries, and people like Unruh, Finger, and Coburn would relegate those they consider to be "promiscuous" to a death sentence, or with otherwise having to wrestle with a deadly disease for the rest of their lives all in the name of a faith-based moral agenda. That is morally wrong, in fact unconscionable in any rational perspective except, it appears, the Christian Right's. There are many good reasons to be working to cause a change in this government, and frankly Specter's article highlights an excellent one.

8 Comments:

I'm not sure that comparisons with alcoholism or diet-induced diabetes are appropriate - maybe if you're only talking about extremely promiscuous individuals who have lots of unprotected sex, but you can get HPV from having a perfectly normal monogamous sex life. That's more analagous to having a few drinks occasionally than being an alcoholic or binge drinker!

It's weird that some people argue that abstinence (until marriage) protects against HPV, as though there's some magic that stops you catching it from your married partner (unless you're 100% sure they were abstinent until they met you, and who can be that sure?).

Can't you also catch HPV just by skin contact, without necessarily having sex?

I agree, the analogies may not be entirely apt. My intention was to draw what, under a particular line of thinking, would be considered an apt response to the results of behavior we feel that we should have control over and, if we're "good" people (whatever the heck that means exactly, though I'm sure Christian readers of the ilk of Ms. Unruh would be able to define this), be able and expected to avoid. Of course abstinence is an act of ommission, the analogies used are decidedly acts of commission, but if a Christian should consider decidedly unChristian acts such as excluding the use of a vaccination, for HPV or AIDs, then it seems that they should have similar logic for equally unChristian acts like taking care of those whose afflictions are largely due to their own actions.

As for HPV, yes, it does appear that sexual contact isn't required. You can apparently be infected by the virus from simple skin-to-skin contact.

After having a family member get a cervical cancer scare at just over thirty, I am for ANYTHING that would possibly reduce risk for my kids. I have no idea how stupid you have to be to deny that this is a good thing, but your analogies are not unlike the ones I think up in the dark when I am steamed and angry and cannot sleep so I stew instead. How arrogant and nasty your government seems. I hope where I come from we do get this vaccine.

Lifestyle is NOT necessarily an indicator of bad things happening. We all know folks who eat smoke drink to excess and live til their eighties. Who can say for sure that there are not genetic variations or environmental factors beyond anyone's control that make something small turn into a big life change? While another person with a risky lifestyle gets a free pass?

All I can say is let one Rep. man have a daughter die needlessly of this disease. Not unlike the Reagans and stem cells, I can almost guarantee they will think it is a good idea only when it happens to them personally.

I have to go, I am so angry, and I am afraid bad words will come out of the keyboard.

I saw your link in Tangled Bank and read your piece. As someone who works a lot with the pharma industry, I'm reasonably famiiar with vaccine politics. Your piece and the many links and comments I checked did not sound quite right to me. Unfortunately, the Specter article is not on line, so I was only able to read the short interview with him, but that was sufficiently clarifying.

The dispute in question is not whether to approve the vaccine, but whether it should mandatory. There are many good reasons to get vaxed for HPV, and I wouldn't hesitate for a moment, not for my daughters or me.

However, mandatory vaccination is another question altogether. There is a lot of ignorant ant-vax stuff out there -- far from all of it promoted by fundamentalist Christians, by the way. Unless a compelling epidemological case can be made, mandatory vaccinations are politically difficult. In this case especially, where HPV is not quickly or even directly fatal and, even though it can be spread other than sexually, not easily transmitted publicly, it is not that big a deal.

Far more dangerous is the anti-vaccination campaign against the early childhood disease vaccinations for infants. Since it does not allow its readers to engage in self-righteous hatred against people they despise, though, the NY'er is not up in arms about that.

More disturbing is the crude and vicious--at the vert least; it's actually much closer to totalitarian propaganda--smears involved here. And this from people who claim that they are on the side of facts and science.

“The dispute in question is not whether to approve the vaccine, but whether it should be mandatory.”

It’s not about mandatory versus voluntary, and frankly that distinction is one of splitting hairs. It’s about people in positions to affect or create policy who don’t use science as the primary tool by which to form the best policy for the public good vice their own agendas. I quoted Dr. Finger who clearly believes that the HIV virus serves as an agent of good with regard to scaring people into abstinence; there are clearly people out there who strongly believe we flat out shouldn’t have the vaccinations in question.

In the case of the HPV vaccine it’s hard to imagine that the primary sticking point over the vaccine would in fact be mandatory versus voluntary – we mandate vaccinations for highly contagious diseases, not, as you yourself point out, for diseases that ten year-old children are not apt to be exposed to. But vaccinating children at that age clearly does significantly reduce their risk of cancer as adults, something parents should have access to if they desire and I can only imagine what anyone who believes that HIV serves as a disinhibition would say about an HPV vaccine.

The New Yorker article specifically addresses this issue as a matter regarding how government policy is created under the current administration, specifically with regard to the influences in the process. The specific focus is with those in policy positions who are currently determining how policy should be shaped, and how they are more focused on their moral values and religious beliefs with regard to how policy should be, NOT science. Parents who opt out of vaccinating their children, a legitimate problem in this country, is an individual choice made largely by ignorant people who seemingly are able to live with endangering the lives of their children, hardly a national policy issue when the policy itself supports mandatory vaccinations for specific illnesses.

Your other comment:

“More disturbing is the crude and vicious--at the vert least; it's actually much closer to totalitarian propaganda--smears involved here. And this from people who claim that they are on the side of facts and science.”

We clearly differ on the meaning of the words "crude", "vicious", “totalitarian”,“propaganda”, and “smear”, as I see none of these adjectives as being in the least applicable here. That said, your own agenda seems pretty clear enough.

James: The policy in question, as best as I understand it, has to do with making the vaccinations mandatory or not. As you allude to, even when vaccines are mandatory, enforcement is difficult.

There certainly is a distinct scientific question involved, which is whether lowering the risk of getting HPV lowers inhibitions to promiscuity. I don't know it has been studied or not.

This is, of course, conflated with a non-scientific quesiton, which is the desirability of that outcome. Since this question is a matter of familial morality, and since HPV is not in the quickly-spread epidemic category, I think that making the vaccination for minors would be a very difficult political act. At 18, people can decide for themselves. As I said, though, I think that not getting the child vaccinated would be a mistake and irresponsible as well.

The problem scientists, doctors, techs, etc., is perfectly exemplified by your attitude: "The science proves it, anyone who disagrees is a dangerous religious fanatic, etc.," which is where I get my five adjectives from, and from which you have done nothing to diminish their appropriateness.

In my experience with getting parents who refused vaccinations for their children out of the supposed autism/mercury link, I found that simply listening sympathetically, asking them open questions, discussing the matter, and addressing their fears was in all but one case (very small sample, though: seven altogether), sufficient to change their minds.

As far as this Bush appointee is concerned, well, that's the price for losing elections. Furthermore, there are always going to be some, er, eccentric, appointees, especially at the lower levels. Politics is going to wildly interfere with science, all the ime, and always well: forcing medical insurance to pay for pseudo-scientific "alternate" (non)cures, insane jury decisions, the demise of nuclear power because of the "China syndrome" movie, or whatever it was called, scientifically illiterate anti-Darwin stickers on textbooks--on and on. That's just a fact of life.

If people in science, however, act the way you and so many others do, you've lost before you've begun. I agree with your position, essentially, but people have to be persuaded. Parents do not have your (and mine, for that matter) luxury of imposing policy on other people's children. It's frightening to be a parent, and you can't trust anybody else to care more about them than you.

I didn't know my agenda was so obvious, but I'd like to know how you figured it out so easily. I'll list my agenda here, and if you have a moment, please put a quick note in telling me how you figured each one out.

Agenda:1) Get employer to accept that reality is unaffected by lengthy verbal or written declarations of company policy.

I don’t see this as a policy issue, rather an issue regarding how policy is made. The specific problem is that when those in positions to make policy allow their religious/moral beliefs to be imposed on the rest of us there’s a problem. And I don’t see vaccination enforcement as a problem – you don’t get to go to school or work if you don’t have your vaccines, it’s that simple, and historically, on the whole, that seems to work pretty well.

As for HPV vaccination lowering inhibition to promiscuity, obviously that hasn’t been studied inasmuch as the vaccine isn't available to the public as a whole as of this writing. Of course before such a study can be started we’d have to define “promiscuity”, and then why it’s the government’s business who’s promiscuous or not. Bearing in mind that we’re not interested in merely protecting the “promiscuous”, whoever or whatever they may be, but those who may be anything but promiscuous but who find themselves with partners who may have been less so. Medically speaking the issue of promiscuity is ridiculous – it’s a vaccination, not a chastity belt.

Conflated with a non-scientific issue which has to do with familial morality – I'm sorry, but I never broached this as a mandatory case of applying the HPV, and certainly that wasn't where the New Yorker article was coming, which was very focused on the administration imposing morality/religious views on scientific deliberations. So if a family wants to forgo vaccinations and leave it to their 18 year old child great - I think it's needlessly risky, but it's their call.

As for what science may or may not “prove”, I know that there’s a vaccination that exists, it is being resisted by people in government who feel that such vaccinations encourage what they deem to be immoral behavior, and I think that’s wrong. I’m not sure what the specific problem is that I have – I’m sure the vaccine exists, it works after ample testing – where does science come into this as a problem?

I commend your tactics with parents who clearly don’t understand science and how it works, but my audience here is not that, it’s something quite different, and I’m not trying to convince anyone that they should be vaccinated. I’m arguing that the availability of a vaccine shouldn’t be stymied by someone in the government because they think it’s a disinhibitor.

Thank you for the synopsis on the price of losing elections. I think I’m using the time-honored practice of voicing my opinion/concern in a democracy, which also has a wonderful pedigree to it. When people who are poorly suited to their government positions are identified then it’s incumbent upon those of us who care to do something about it, even if it’s only voicing a concern.

You seem to forget where you encountered this blog – at the Tangled Bank, remember? I wasn’t writing for an audience that I felt compelled to “convince” about getting the HPV vaccine. People who tend to go to the TB are pretty scientifically focused and literate and they don’t need me to convince them of anything. I was shedding light on something that some of them may not have been aware of, not trying to convince them that they need to come to my way of seeing things. I assure you I am sensitive enough to my audience to appreciate how I may have to respond to it, though you seem to have lost sight of who I was talking to and why.

Your agenda – that was presumptuous of me, surely, and I apologize. That said I didn’t appreciate the unnecessary inflammatory and hyperbolic statements you were making in your comment. For a guy so fixed on giving me advice on tactics with regard to positively persuading my audience, well, let’s just say, “Physician heal thyself.”